A nomogram-based model to personalize growth hormone pretreatment in assisted reproductive technique for prediction of oocyte retrieval and embryo quality

Anser, Romaisa and Fatima, Sampana and Mukhtar, Bushra and Shaid, Fazlina (2026) A nomogram-based model to personalize growth hormone pretreatment in assisted reproductive technique for prediction of oocyte retrieval and embryo quality. PHYSIOLOGY INTERNATIONAL, 113 (1). pp. 64-80. ISSN 2498-602X

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Abstract

Objective: To develop and validate a predictive nomogram for oocyte retrieval and embryo quality based on personalized growth hormone (GH) pretreatment in women undergoing assisted reproductive techniques (ART) with diminished ovarian reserve (DOR). Methods: 2,000 women ≤40 years, diagnosed with DOR, were non-randomly assigned to one of four groups based upon hormonal and metabolic markers: G1 (1-month GH pretreatment followed by ART), G2 (2-month GH pretreatment), G3 (GH given only during ovarian stimulation), and G4 (standard ART without GH). 2 IU/day of GH was given to women from G1-G3, hormonal profile was repeated and dynamic stratification was done. Results: The G2 group showed significantly higher estradiol levels, more oocytes retrieved, and a higher proportion of goodquality embryos compared to G1, G3, and G4 (P < 0.001). HOMA-IR levels were elevated in the G2 group, indicating increased insulin resistance with prolonged GH exposure. Multivariate regression identified GH dose (β 5 0.48, P < 0.0001) and AMH (β 5 0.35, P 5 0.0013) as strong positive predictors, while HOMA-IR (β 5 0.22, P 5 0.012) and testosterone (β 5 0.29, P 5 0.028) negatively impacted outcomes. The nomogram modelled through multivariate regression provides a clinically effective tool for personalization of GH pretreatment. Conclusions: The study demonstrates that GH pretreatment significantly enhances oocyte retrieval and embryo quality. A nomogram-based predictive model stratifies patients, supports the personalization of GH treatment duration, and offers a clinically useful tool toward precision reproductive medicine.

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